TAVI的前世、今生和未来

Transcatheter aortic valve implantation-yesterday,today and tomorrow

近年来,钙化性主动脉瓣狭窄(CAS)发病率呈现逐年上升趋势,患者出现心绞痛、呼吸困难和晕厥等严重威胁生命的临床症状,导致预后极差。外科瓣膜置换术能够明显改善患者的生存质量及预后。然而,传统的外科手术可能导致严重的并发症,尤其是高龄、术前合并其他疾病的患者,因此,超过30%的患者未能接受手术治疗。为解决这一问题,经皮穿刺导管介入的微创技术应运而生。经导管主动脉瓣植入(TAVI)术是将人工生物瓣膜嵌入导管内并在病变的主动脉瓣原位释放的技术。多项临床研究已经表明,TAVI手术能够显著降低病死率,目前全球已完成超过40万例。随着临床数据的积累,TAVI手术的适应证有望进一步扩大。在欧美发达国家已经积累了较为丰富经验的基础上,TAVI介入技术自2010年开始引进我国,初步临床疗效确切,为我国此类患者点燃了生命的希望。虽然现阶段TAVI手术并不是主动脉瓣疾病治疗的金标准,但微创或无创的治疗方法代表着未来瓣膜外科的发展方向。

The incidence of calcific aortic stenosis（CAS） is increasing year by year.Patients with CAS suffer symptomsof angina,dyspnea,syncope as a consequence and poor prognosis.Surgical valve replacement can significantly improve thelife quality and prognosis of patients.However,traditional surgery can lead to serious complications,especially for olderpatients with preoperative complications.As a result,more than 30% of patients were unable to undergo surgical treatment.Transcatheter aortic valve implantation（TAVI）,a technique in which a bioprosthetic valve is inserted via a catheter andimplanted within the diseased native aortic valve,is a new therapeutic modality for treatment of older patients with severecomorbidities.Many clinical studies have showed that TAVI can significantly reduce mortality.That over 400 000 TAVIprocedures have now been performed worldwide.With the accumulation of clinical data,the indications for TAVI can beexpanded to young and low risk patients.On the basis of the rich experience accumulated in developed countries in Europeand America,TAVI intervention technology has been introduced in China since 2010.It has a definite clinical effect,whichhas kindled the hope of life for such patients in our country.Although TAVI surgery is not the gold standard for the treatmentof aortic valve disease at the present stage,minimally invasive or noninvasive therapy represents the development direction ofthe future valvular surgery.